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#1 of 11 Old 04-15-2011, 09:54 AM - Thread Starter
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This is my first planned hospital birth so I haven't ever had the need to do a birth plan but my OB requested one. Here is what I have so far.  I have already forwarded a copy to my doula and one of my friends who is an L&D nurse at our local hospital for their input. Led me know what you think- did I leave out anything or word anything weirdly???


Birth Plan
Mother- Evergreen
Partner- Mr. Evergreen
Support-Doula XXX

Estimated Due Date- May 29, 2011
Blood Type- B+
Allergies- None
Care provider- Dr. XXX

My wishes for birth regardless of hospital policy. I understand these are all subject to change in the event of an emergency.

Before Labor
1. I do not want to be induced or have my membranes/fluids artificially ruptured.
2. If I am 42 weeks with no signs of impending labor I would like an AFI, NST and the option to reevaluate the above statement.
3. I prefer to use pitocin as a last result for induction and to not use cytotec at all.
1. If I am not in active labor or am less than 5 cm dilated I will go home.
2. If I am becoming dehydrated I will ask for IV fluids. I decline an IV under normal circumstances.
3. I would like 20 minutes of external fetal monitoring upon being admitted. As labor progresses I would like the baby’s heart rate to be intermittently monitored with a Doppler.
4. I plan to labor in different positions and move around as much as possible.
5. I plan to utilize the shower and would prefer to be undisturbed while in the bathroom.
6. Please keep vaginal exams to a minimum and by consent only.
7. I do not wish to have my waters artificially broken at any time during labor.
8. I am planning a natural childbirth but if I want an epidural I will ask for one. If I decide pain relief is necessary I would only like epidural or spinal anesthesia as my body reacts poorly to Nubain, Stadol and Demerol.
9. I wish to have friends and family present while in labor.
10. If I am GBS + I would like IV antibiotics administered via heplock.
1. Please do not tell me when to push even if I am 10 cm.
2. I do not want an episiotomy.
3. I will not push flat on my back. I may choose to utilize different positions which include squatting and on my hands and knees.
4. We do not know the sex of the baby. Nobody is to announce the sex (including Mr. Evergreen) until Evergreen has had the opportunity to see.
5. Please keep the room as dimly lit as possible and keep noises to a minimum as not to scare the baby.

Post Birth
1. I would like to hold the baby and initiate breastfeeding immediately.
2. I would like my husband to cut the cord when it stops pulsating.
3. All newborn assessments should be performed in my room.
4. I would like eye ointment and Vitamin K to be administered to the baby after he or she has had a chance to breastfeed fully.
5. I decline the Hepatitis B vaccine at this time (I am Hep. B negative)
6. I would not like the baby to be bathed.
7. I wish to take the placenta home.
8. If the baby is a boy he is not going to be circumcised.
9. No bottles or pacifiers.

Evergreen- Loving my girls Dylan dust.gifage8, Ava energy.gifage 4 and baby Georgia baby.gif (6/3/11).

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#2 of 11 Old 04-15-2011, 10:53 AM
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Looks good to me.  thumb.gif



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#3 of 11 Old 04-15-2011, 11:51 AM
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i like it, in fact, i may steal it.

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#4 of 11 Old 04-15-2011, 12:06 PM
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My input is that #1 and #7 of labor is repetitive. I think #7 was covered in #1 entirely.

You should review the hospital guidelines too regarding certain things, first for example- taking home your placenta. Some hospitals will allow you to- others will not. It's hospital policy and not up for debate, unfortunately :/


For ME Im having another waterbirth and the fact this is #7 they want me to have an IV line inserted JIC. Mostly being that if I WERE to bleed out (rates go higher the more kids you have) then its very hard to insert an IV line because your veins collapse. So, I am giving in on that one and allowing them to insert an initial IV line but not hook me up. It also allows them to administer instant pain management after the baby is born if needed ( Ive needed that in the past).


You might also mention something about pushing on your belly when it is not needed. The nurse immediately pushed on my belly with my 6th because she felt she was helping me contract out the placenta even though I was doing fine on my own without complications or signs of bleeding out.
Check out the stats on Cervadil to induce and mention that in there too. A gal from my church was induced with it and she had placental abruption as well as fetal distress leading in a c-section- suspiciously from the Cervadil. I would put something in there about sweeping your membranes, etc to help with starting labor before meds.


How are you with pain meds after birth? The afterpains are going to be MUCH harder with this one than your first and 2nd. They get worse after each child, Im afraid. I personally ask for percacet to manage my after pains for at least the first 2 days after the baby (for ME and it's a little scary because percacet didnt hardly touch my pain with Emmalia last time and Im talking 30+ minutes HARD labor-like contractions while nursing or general moving) but you might discuss post pain management knowing that this is going to be something you are going to be dealing with.


Keep in mind that, for as HORRIBLE as an episiotomy is- if there is an emergency I would choose one over a c-sec. They may tell you NOT to push yet even if you feel the urge to push only because you might have a lip or so of cervix left that is starting to swell or if there is presentation of the cord first and they might also tell you to push if the baby is listless and needs delivering asap.


What about feeding the baby sugar water or formula? Some nurses do it routinely. Depending on the situation, I would put in there your preferences on what they are allowed to feed the baby. All I can think of at the moment :)


-Jyn, Blessed mom of Abbie ('99), Gracie ('00), AngelBaby ('01), Danny ('02), Jacob ('03), Eva Bella ('06), Angel-Baby2 ('07), Emmalia ('09), Justus John Mark ('11), Jude Ellias Due 7-16-13

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#5 of 11 Old 04-15-2011, 01:13 PM
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Am I foolish for not having a birth plan?  I've never had one before (but all were planned HB turned hospital transfer and C/S) and DH knows the routine.  He is NOT to leave the baby under any circumstances and will not allow eye ointment, Vit K, vax, bathing, etc. 


This time I plan a hospital VBAC if I go into labor by 40 weeks or likely a RCS if after 40 weeks.  The OB is barely supportive of the VBAC (because of circumstance in IL, he's rare for even agreeing to "let" me try.)  I don't want to be too pushy with a birth plan, when DH and I know my desires and are strong enough to voice them when the time comes. 

Mom to 5 amazing kids! (DS10, DS8, DD5, DD3 and DS1)
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#6 of 11 Old 04-15-2011, 04:45 PM
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The eye ointment is for in case you have chlamidia or gonerrhea (sorry about spelling.) 

If you don't have those, I'd recommend declining the eye ointment, personally. 


From what I have read online. "I do not consent to" are the magic words that will be most likely to be considered. 


For example, "I do not consent to receiving Nubain, Stadol or Demerol."


Here's my birth plan in case it could be useful to anyone. I'd have included a couple other things but I'm not actually going to the hospital unless there's an emergency.



Formatting kinda sucks but you get the idea...




Page 1

Dayiscoming Birth Plan

Mother-to-be: Dayiscoming 

  Partner: DH


  Due Date: 05/08/11    


Nothing should be done to me or baby without informed consent.

First Stage (Labor):

  • No students, residents etc.
  • Keep vaginal exams to a minimum
  • Maintain mobility (Walking, rocking, up to bathroom, etc.)
  • Eat and drink to comfort.
  • No IV – heparin lock acceptable, if necessary.
  • Intermittent Monitoring (ACOG Standards)

Second Stage (Birth):

  • Choice of position
  • no directed pushing
  • No pitocin or cord traction for removing placenta (Placenta should deliver on its own.)
  • Will try breastfeeding right away after baby is born to aid in delivery of the placenta and clamping down of uterus.
  • Delay the cord cutting (until pulsated stops) – especially important if baby has breathing troubles

Baby Care:

  • I do not consent to separation of mother and baby except in the case of a true medical emergency
  • I do not consent to eye ointment, vaccines or vitamin K
  • Breastfeeding only
  • I do not consent to pacifiers, formula, or glucose water

·         If baby is hypoglycemic, I will breastfeed to treat it.  My second choice is my pumped breast milk administered using a non-nipple feeding method. 

  • No circumcision if a boy





Birth Plan for Dayiscoming                                                    Page 2

Emergency Cesarean Section:

·         Follow “Baby Care” section after the C-Section.

·         I do not consent to placement of a urinary catheter until after anesthesia is administered.

·         I do not consent to single layer suturing of my uterus.  A double layer closure must be used.

·         I do not consent to staples for my skin layer and instead I want sutures.

·         Bulb suctioning only, unless baby shows signs of problems. Deep suctioning to be done with a mobile unit with baby at my immediate side.

·         I do not consent to students or interns watching or participating.

·         I do not consent to having my arms tied down unless I am physically unable to control them.

·         Conversation between staff to be kept to a minimum, with the focus being on making me feel as at ease as possible and kept informed as to what is taking place.

·         All medications offered for pain relief afterwards need to be breastfeeding friendly.

·         Breastfeeding should be established as soon as possible.

·         I do not consent to tranquilizers or sedatives being administered.


Happily married Christian SAHM of 2 boys, DD1 uc.jpg, and DD2 July 2013 homebirth.jpg 

 homeschool.gif   novaxnocirc.gif cd.gif   winner.jpg                                       


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#7 of 11 Old 04-15-2011, 05:31 PM - Thread Starter
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Jyn- Thanks! I know that the hospital does allow people to take their placentas but sometimes they get in a rush and get rid of them quickly.  I had forgotten all about the pitocin/uterine massage after birth. I will need to add something to address that. I appreciate your reminding me! 


dayiscoming- Yeah, I know what the eye ointment is for and for reasons I'd rather not get too detailed about I want it. I wasn't going to do a Csection plan because I figured by that time everything would be out the window, but you reminded me that I want a double suture and not staples should a C section become nec.  I think I will have to include it in the plan.


jr'smom- My OB specifically asked for a birthplan so I don't know if you want to do one or not. Maybe something short and sweet like dayis's would be good just to have what you want written out.

Evergreen- Loving my girls Dylan dust.gifage8, Ava energy.gifage 4 and baby Georgia baby.gif (6/3/11).

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#8 of 11 Old 04-16-2011, 08:57 AM
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Just to add some ideas:



Pre Admission – we request:

  • Inducement only for medical urgency, no sooner discussed than 41.5 weeks
  • Inducement by natural means first, with pitocin or gels only as a last resort
  • To remain at home for as long as possible before heading to the hospital

For Admission – we request:

  • To decline an IV, to walk when at all possible
  • To return home if less than 4 cm dialated

During opening and thinning phase of labor:

  • To refrain from any interference in the natural course of labor without our authorized consent
  • To refrain from offering or discussing pain or medication unless we bring it up
  • Intermittent monitoring only unless there is medical necessity
  • No internal monitoring in absence of fetal distress and without express permission
  • To take nutritional snacking if labor is prolongued
  • To walk and change positions as I desire throughout labor especially during delivery
  • Minimum of vaginal exams and only with permission
  • To enjoy hydrotherapy!
  • To use natural oxytocin stimulating methods to augment labor (and be accorded the privacy to do so) such as nipple and clitoral stimulation
  • No augmentation of labor via pitocin, amniotomy, or stripping of membranes without discussion and express verbal consent


  • Mother directed breathing instead of OB-directed “pushing” down the baby
  • To use hypnobirthing techniques without staff prompts
  • Calm low tones from the staff please
  • Birthing stool, bed for squatting, or other mother-directed positions for birthing
  • Hot compresses to avoid episiotomy
  • Allow father to catch baby if he wishes
  • Uterine massage and nipple stimulation to help deliver placenta before drugs

For Baby:

  • Low lights if possible
  • Immediate skin to skin, no excessive rubbing or cleaning needed
  • Delay cord clamping until pulsation has ceased
  • Skin to skin contact for 2 hours uninterrupted if baby is healthy and mother is healthy
  • Delay eye drops until 2 hrs bonding complete for optimum sight during bonding
  • Male baby: NO CIRCUMCISION
  • Oral Vitamin K if available, after bonding time
  • Breastfeeding only please, baby to remain with mom for as long as possible
  • Please ask Dad and get consent for anything regarding the baby if mom is not available
  • No Hep B Vaccine – we are delaying this two months

Anna, married to my soulmate, loving on DS (4)
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#9 of 11 Old 04-16-2011, 11:15 AM
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My first birth plan looked a lot like yours. My only 'mistakes' were not to think about post birth pain relief (I had a big tear and needed lots of stitches and a local would have been wonderful had I though it through rather than just saying no) and not to include something about circumcision.

I am with midwives this time so I have left out a lot of the don't do this language because that is not how they work. Instead I focused on telling about me and how I labour. They have had the plan since around 32 weeks and all four love the NST test point.


Leigh PF & Birth

My first baby was 9 lb 2 oz. No Epidural. I am tough.

My name is Leigh, only my children may call my Mom or Mommy.

My husband is J.


Stage One

·           I feel that Chocolate Pudding is an essential part of a NST test.

·           My experience last time was that labour was hard work and I was fine as long as I could be get down to it.

·           I don’t concentrate on my breathing, it just messes me up. I count.

·           I find having concrete progress markers helpful and would like to be told how many centimeters dilated I am.

·           I found washcloths soaked in ice water and placed on my belly very helpful last time.

·           I will ask for pain medication if I feel I need it.


Stage Two

·           Please let Joel tell me the sex of the baby

·           I did not like being told when to push last time


Stage Three and Afterwards

·           I was very cold after the birth of my first child and would like to have a warm blanket available this time.

·           If I tear and need stitches, I would like pain relief.

·           If the baby is a boy we will not be circumcising.

·           We plan to donate the cord blood to a public bank

·           My baby will be exclusively breastfed.

·           I'm interested in checking out of the hospital early.

Family Doctor: Dr. S phone #

Mama to J (Jan '09), E (May '11), and C (August, '13)

Professional Cloth Diaper at Diaper Lab in Boston (ask me about laundry)
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#10 of 11 Old 04-16-2011, 01:55 PM
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@Leigh- I LOVE the "only my kids call me mom or mommy" !!


As both a doula and during my own births, I've found that the more concise a birth plan the better. (Not that I am recommending to omit anything- but if certain practices are standard, i.e. 20 minute fetal monitoring strip upon admission- which you've mentioned in your plan- I wouldn't mention it.) Also- do you have plans for including an "in the event of a cesarean section" which may include not using a drape/having your partner remain with the baby/bringing baby to you immediately after delivery, etc?  We've also included an introductory sentence in ours, i.e. "very much looking forward to working with our providers" and "we've prepared for an intervention free birth using The Bradley Method." Just a thought.  


This is our first HB and your thread was a lovely reminder that I need to write a plan in case of transfer- thank you!!!

J - Birth doula and *very* grateful mama to bouncy Q, fancy F, and mighty F!

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#11 of 11 Old 04-16-2011, 07:33 PM
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